Two Kinds of Patient-hood

Pellegrino writes (quoted in Ackerman, pg.74): "The state of being ill is therefore a state of 'wounded humanity,' a person compromised in his fundamental capacity to deal with his vulnerability."

I suspect that there are two ways to understand the notion of "patient-hood" and its relation to patient autonomy. The first way is this: to regard a patient (=a person suffering illness of some serious degree) as being different from a healthy person in some fundamental way. According to this understanding of patient-hood, illness diminishes an essential quality that comprises a human being, namely, autonomy. The second way to understand the concept of patient-hood is to regard a patient as being different from a healthy person in some "merely" temporary aspect, and that a patient is no different from a healthy person except that a patient's life is inhibited by illness.

Example: We would not regard John (who is an average guy) in a drunk state is fundamentally different from John in his normal waking state. Once John becomes sober, he will return to his normal self--so drunkenness is only a temporary alteration, an inhibition that can be lifted. But if John lost a part of his mental capacity (say, to recognize people's faces), perhaps as a result of an accident, it is likely that we regard post-accident John as being somehow fundamentally different from pre-accident John.

Why does distinguishing the two ways to understand patient-hood matter?

The first way of understanding patient-hood supports paternalism. If patient-hood implies a loss in the patient's capacity for autonomy, then it is unclear how the patient's autonomy can be respected in the first place. There is no overarching patient autonomy that physicians must respect; rather, the aim of medical treatment becomes eliminating the factors that inhibit patient's autonomy--that is, curing the illness becomes the overarching aim. Patenralism, thus, can be justified on instances where it would lead to better consequences for the patient.

The second way of understanding patient-hood supports patient autonomy. Since autonomy is something that must be respected in all occasions (perhaps there are exceptions; eg. when autonomy is voluntarily relinquished), and since the second concept of patient-hood regards patients as possessing the capacity of autonomy just as much as healthy people, it should follow that autonomy must be considered as something that is to be respected even if it means that a patient will be worse off in the long run.

Now, I am open to the possibility that in some cases, the nature of an illness is so that the first understanding of patient-hood is more plausible, while there may be cases where the second understanding is better suited. What such a possibility implies, I think, is clear.